Instructions for Week 3 Project Due: 8/3/2020Assignment 2—Application of a Behavioral TheoryPublic health interventions are now guided primarily by theoretical frameworks. There is a strong correlatio
PHE4095 SPECIAL TOPICS IN PUBLIC HEALTH WEEK 3 LECTURE
Commission on Social Determinants of Health
In 2005, to decrease the health inequality between and within countries, the World Health Organization (WHO) organized the Commission on Social Determinants of Health. This global network of professionals was formed to address health inequities and provide recommendations to the acting director-general of the WHO.
The commission included global leaders in the areas of policy-making, research, academia, and civil society organizations. Research was conducted across the globe from 2005 to 2008 to collect evidence on policies and interventions to reduce health disparities. The idea behind the commission was to look beyond the cause of disease and critically evaluate the complex global processes that contribute to the health inequality between and within countries (WHO: Commission on Social Determinants of Health, 2008).
The commission released their final report in August 2008. Based on the evidence gathered from the three-year project, they made three predominant recommendations (WHO: Commission on Social Determinants of Health, 2008):
Improve daily living conditions
According to WHO (2008), at least 200 million children globally were not achieving their full potential (p. 50). This would have huge implications for the future of society. The commission slated that the number of children living in slums was unconceivable. A priority of the commission was to ensure more available housing for families that would provide clean drinking water, sanitation, and electricity.
Tackle the inequitable distribution of power, money, and resources
The inequality of daily living is shaped by more than the social processes in place. Many of the policies and governmental practices that are in place actually promote the unfair distribution of resources. The commission noted that such problems needed to be addressed.
Measure and understand the problem and assess the impact of action
The commission called for a more effective data collection system to monitor health inequities and social determinants of health
In continued support of the commission’s recommendations, the World Health Assembly adopted the Rio Political Declaration on Social Determinants of Health in May 2012. The WHO member states voiced their political determination to improve public health and reduce health inequities (WHO, 2012).
Social Determinants of Health
To understand health programs, social determinants of health must be understood:
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In This Section
Development of Healthy People 2030
Framework
Public Comment
Advisory Committee
Committee Reports and Meetings
History & Development of Healthy People 2020
Objective Development and Selection Process
Advisory Committee
Federal Interagency Workgroup
Lead Federal Agencies
Healthy People 2020 Workgroup Coordinators
Foundation Health Measures
Foundation Health Measures Archive
How to Use HealthyPeople.gov
FAQs
Determinants of Health
What makes some people healthy and others unhealthy?
How can we create a society in which everyone has a chance to live a long, healthy life?
Healthy People 2020 is exploring these questions by:
Developing objectives that address the relationship between health status and biology, individual behavior, health services, social factors, and policies.
Emphasizing an ecological approach to disease prevention and health promotion. An ecological approach focuses on both individual-level and population-level determinants of health and interventions.
About Determinants of Health
The range of personal, social, economic, and environmental factors that influence health status are known as determinants of health.
Determinants of health fall under several broad categories:
Policymaking
Social factors
Health services
Individual behavior
Biology and genetics
It is the interrelationships among these factors that determine individual and population health. Because of this, interventions that target multiple determinants of health are most likely to be effective. Determinants of health reach beyond the boundaries of traditional health care and public health sectors; sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health.
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Policymaking
Policies at the local, state, and federal level affect individual and population health. Increasing taxes on tobacco sales, for example, can improve population health by reducing the number of people using tobacco products.
Some policies affect entire populations over extended periods of time while simultaneously helping to change individual behavior. For example, the 1966 Highway Safety Act and the National Traffic and Motor Vehicle Safety Act authorized the Federal Government to set and regulate standards for motor vehicles and highways. This led to an increase in safety standards for cars, including seat belts, which in turn reduced rates of injuries and deaths from motor vehicle accidents.1
Social Factors
Social determinants of health reflect the social factors and physical conditions of the environment in which people are born, live, learn, play, work, and age. Also known as social and physical determinants of health, they impact a wide range of health, functioning, and quality-of-life outcomes.
Don’t miss the Social Determinants of Health topic area and objectives.
Examples of social determinants include:
Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
Social norms and attitudes, such as discrimination
Exposure to crime, violence, and social disorder, such as the presence of trash
Social support and social interactions
Exposure to mass media and emerging technologies, such as the Internet or cell phones
Socioeconomic conditions, such as concentrated poverty
Quality schools
Transportation options
Public safety
Residential segregation
Examples of physical determinants include:
Natural environment, such as plants, weather, or climate change
Built environment, such as buildings or transportation
Worksites, schools, and recreational settings
Housing, homes, and neighborhoods
Exposure to toxic substances and other physical hazards
Physical barriers, especially for people with disabilities
Aesthetic elements, such as good lighting, trees, or benches
Poor health outcomes are often made worse by the interaction between individuals and their social and physical environment.
For example, millions of people in the United States live in places that have unhealthy levels of ozone or other air pollutants. In counties where ozone pollution is high, there is often a higher prevalence of asthma in both adults and children compared with state and national averages. Poor air quality can worsen asthma symptoms, especially in children.2
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Health Services
Both access to health services and the quality of health services can impact health. Healthy People 2020 directly addresses access to health services as a topic area and incorporates quality of health services throughout a number of topic areas.
Lack of access, or limited access, to health services greatly impacts an individual’s health status. For example, when individuals do not have health insurance, they are less likely to participate in preventive care and are more likely to delay medical treatment.3
Don’t miss the Access to Health Services topic area and objectives.
Barriers to accessing health services include:
Lack of availability
High cost
Lack of insurance coverage
Limited language access
These barriers to accessing health services lead to:
Unmet health needs
Delays in receiving appropriate care
Inability to get preventive services
Hospitalizations that could have been prevented
Individual Behavior
Individual behavior also plays a role in health outcomes. For example, if an individual quits smoking, his or her risk of developing heart disease is greatly reduced.
Many public health and health care interventions focus on changing individual behaviors such as substance abuse, diet, and physical activity. Positive changes in individual behavior can reduce the rates of chronic disease in this country.
Examples of individual behavior determinants of health include:
Diet
Physical activity
Alcohol, cigarette, and other drug use
Hand washing
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Biology and Genetics
Some biological and genetic factors affect specific populations more than others. For example, older adults are biologically prone to being in poorer health than adolescents due to the physical and cognitive effects of aging.
Sickle cell disease is a common example of a genetic determinant of health. Sickle cell is a condition that people inherit when both parents carry the gene for sickle cell. The gene is most common in people with ancestors from West African countries, Mediterranean countries, South or Central American countries, Caribbean islands, India, and Saudi Arabia.
Examples of biological and genetic social determinants of health include:
Age
Sex
HIV status
Inherited conditions, such as sickle-cell anemia, hemophilia, and cystic fibrosis
Carrying the BRCA1 or BRCA2 gene, which increases risk for breast and ovarian cancer
Family history of heart disease
References
1Centers for Disease Control and Prevention. Achievements in public health, 1900–1999 motor-vehicle safety: A 20th century public health achievement [Internet]. MMWR Weekly. 1999 May 14;48(18);369–74 [cited 2010 August 27]. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4818a1.htm.
2State of the Air [Internet]. Washington, DC: American Lung Association. Available from: http://www.stateoftheair.org
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3Agency for Healthcare Research and Quality (AHRQ). National healthcare disparities report, 2008. Rockville (MD): U.S. Department of Health and Human Services, AHRQ; 2009 Mar. Pub no. 09-002. Available from: http://www.ahrq.gov/qual/nhdr08/nhdr08.pdf [PDF – 2.6 MB].
Additional Resources
Commission on Social Determinants of Health. Closing the gap in a generation: Health equity through action on the social determinants of health [Internet]. Geneva: World Health Organization; 2008 [cited 2010 May 10]. Available from: http://whqlibdoc.who.int/hq/2008/WHO_IER_CSDH_08.1_eng.pdf [PDF – 4.3 MB].
Harris K, Holden C, Chen M. Background information on national indicators for social determinants of health. Paper presented to the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020, National Opinion Research Center; January 5, 2010.
Institute of Medicine. Unequal treatment: Confronting racial and ethnic disparities in health. Washington, DC: National Academies Press; 2003.
U.S. Department of Health and Human Services. Draft report of the Secretary’s Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 on Social Determinants; revised 2009 Sep 9.
Wilkinson R, Marmot M, editors. Social determinants of health: The solid facts [Internet]. 2nd ed. Copenhagen: World Health Organization; 2003 [cited 2010 May 26]. Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf [PDF – 470 KB].
Participation in Community Health Programs
Consider the following scenario:
After reviewing and analyzing the community needs assessment data for your city, you and other local health officials have realized that the rate of obesity is extremely high among middle-school youth, and a program needs to be developed to supplement the school’s health curriculum.
The idea you and the task force are proposing is an after-school activity where the students would have physical activity and assistance with preparing healthy snacks. The school board, community leaders, and parents are all supportive and funds have been secured. The only problem is that the schools are in unsafe areas of the city and bus services will not be available to assist the children in getting home safely after the program.
Rather than completely giving up on the program, the task force gathers together again to discuss the environmental factors that may create barriers for participation in the program and strategies to overcome these barriers.
In the above scenario, the two main concerns for the success of this program are (1) safety of the children and (2) transportation home after the program has ended.
The school was chosen as the location of the program since the students would already be in school, and the day could just be extended to accommodate the program. If you were the task force leader, what questions would you pose to your group?
Items that should be considered:
Is there enough staff to escort the children home?
Could bus services be provided to take the children directly to their homes after the program?
Could the community join together and have parents rotate shifts after school to monitor the activity in the neighborhoods surrounding the school?
Is the school the ideal place to hold this program or should the task force start looking into other options (The Community Tool Box, 2012a)?
Strategy to Implement Health Programs
So, where does the task force begin? The ideal place to start is to go back to the community needs assessment and determine what facilities may be available and what resources are lacking. Involving community members and parents in the program development process encourages “buy in” for the program and also makes the members and parents feel like they are contributing to the solution of the problem
You may also wish to review the assessment once again to ensure that you have considered all that the parents have had to say. You may find that they may be interested in becoming more involved in their child’s education without actually being formally part of the parent-teacher association (PTA). In such cases, they could be asked to join the task force. In addition, if the parents choose to have the program closer to their homes, the program could be designed such that parents themselves chaperone the students walking home and rotate this responsibility in shifts (The Community Tool Box, 2012b).
